| Doctor Name: | SUSY ALIAS |
| NPI Number: | 1750332680 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | R9895 |
| Business Practice Address: | 1 Jefferson Barracks Dr Jefferson Barracks, Va Saint Louis, MO - 631254181 |
| Business Phone Number: | 3148946629 |
| Business Fax Number: | 3148455077 |
| Mailing Address: | 1 Jb Drive, Jefferson Barracks ST, LOUIS |
| State: | MO |
| Postal Code: | 63125 |
| Phone Number: | 3148946629 |
| Fax Number: | 3148455077 |
| NPI Enumeration Date: | 05/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | R9895 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |